In this entry I’ve copied two similar articles on the healthcare bill, a December 24 entry at National Review’s healthcare blog by Jeffrey Anderson, “Now is the Time to Fight,” and a December 25 New York Postcolumn by Michael Tanner, “Health Care: Now’s the Hard Part.” Both lay out the great and numerous differences between the Senate and House versions of the bill, and the equally great and numerous differences among various factions of Democrats on what measures they support and oppose. It is on these differences—which seem on the face of it unbridgeable—that the hope of stopping the bill rests. Perhaps the differences will come in the end to nothing, and the irresistible determination of the Democratic leaders to force through a bill will coerce various Democrats into voting for it notwithstanding what they have called their immovable objections to various measures in it. Or perhaps enough Democrats will hold to their objections and the bill will fail.

What role is there for non-Democrats in this process? As Anderson puts it, it is to leave Democrats who occupy doubtful Congressional seats in no doubt that if they vote Yes, they will not be returning to Congress in January 2011.

Now Is the Time to Fight [Jeffrey H. Anderson] (December 24, 2009)

Harry Reid had the Senate meet for 25 consecutive days for the first time since the United States was deciding whether to enter World War I, and he held the Senate’s first vote on Christmas Eve since the 19th century. Such is the zealotry of those who champion the cause of government-run health care. Gaining control over what will soon be one-fifth of our economy is apparently so important that it requires a Christmas Eve vote—for a bill that would essentially start about four Christmases from now.

However, from the start of Christmas week, the important and interesting question was not whether the Senate would pass its bill (that was a foregone conclusion once Ben Nelson yielded to party pressure and waived his abortion objections in exchange for a nice helping of pork). It was whether those of us who believe in the longstanding American ideals of individual liberty, personal freedom, and private control, would continue to match the Democrats’ determination to impose the opposite. For while passage of the Senate bill was a foregone conclusion, follow-on passage of a compromise bill in both chambers is not—not remotely.

The Democrats passed a highly unpopular bill with two votes to spare in the House and none to spare in the Senate. Now they have to blend the bills (mostly reflecting the Senate one) and get them back through both chambers—after hearing from their constituents over the holidays.

Furthermore, the House bill passed only because of relatively strong anti-abortion language demanded by pro-life Democrats in particularly precarious seats. The Senate bill doesn’t contain that language. So either the anti-abortion Democrats in the House or the pro-abortion Democrats in the Senate are going to have to cave. Combine this with other issues, and the Democrats’ almost-nonexistent margin for error, and final passage is anything but certain.

Additionally, the Democrats’ bills would not go into effect in any meaningful way until at least 2013. They could have been written to go into effect immediately, but the Democrats made the calculation that it was better to delay implementation by several years so that they could mislead the American people by citing “ten-year costs” for six years’ worth of Obamacare. That enabled them to pitch an approximately $2.5 trillion bill (its real first-10-year costs, according to the Congressional Budget Office) as an $871 billion bill. But that decision has left us with this reality: The Democrats can only implement their overhaul, and avoid is repeal, if the American people choose to send them back to Capitol Hill and to the White House in 2010 and 2012. The American people, and not the Democratic party, will ultimately decide Obamacare’s fate.

But the American people will also decide the fate of Obamacare in a much more immediate sense. Across recent weeks, Democratic representatives in both congressional chambers have taken tremendous heat from the Obama administration. Now, over the holidays, they’ll get to interact with their constituents face-to-face. They’ve felt the immediate pressures of Washington; now they’ll get to feel the pressure from those who sent them there—the vast majority of whom oppose Obamacare.

They’ll get to hear from people who don’t want to pay higher taxes, higher premiums, and higher overall health costs; who don’t want to lose their consumer-driven health plans; who don’t want to see colossal sums of money siphoned out of Medicare and spent on Obamacare; who don’t want a health-care system based on political cronyism (witness the shameless exemption of the longshoreman’s union from the tax on “Cadillac plans,” and the survival of Medicare Advantage in Florida but not anywhere else). They’ll get to hear from people who don’t want to see a trillion dollars over 12 years be transferred from taxpayers to insurers; who don’t want to see deficits rise and the quality of care fall; and who don’t want to have the federal government inject itself into the historically and rightfully private relationship between patient and doctor.

And the Democratic members better listen. In the wake of Hillarycare’s defeat in 1994, the voters took out their frustrations on typical Democrats, but they went much easier on the more conservative ones who had largely prevented Hillarycare’s passage. So, if history is any guide, those Democrats who vote against the final version of Obamacare (and, in the Senate, against the final cloture motion) will likely be spared, while those who vote for it will invite the voters’ wrath.

In short, now is not the time for anyone who opposes Obamacare to despair or to quit. Now is the time to fight.

Health Care: Now’s the Hard Part
By MICHAEL TANNER
New York Post, December 25, 2009

Harry Reid finally begged, cajoled and bribed enough votes to pass a health-care-reform bill through the Senate. But before Democrats break out the champagne, they should realize that the road to final passage hasn’t gotten any easier.

The bill must now go to a conference committee to resolve significant differences between the House and Senate versions. And history shows that agreement is far from guaranteed.

In fact, just last year, a bill reforming the Indian Health Service died when the conference committee couldn’t overcome its differences on abortion. Similarly, in 2007, bills dealing with issues as varied as campaign-finance reform, corporate pensions and closing tax loopholes passed both chambers but never became law.

In some cases, the conference committee deadlocked. In others, the House and Senate couldn’t even agree on whom to appoint to the committee. And in a highly publicized battle early in the Bush administration, both the House and Senate passed legislation opening the Arctic National Wildlife Refuge to oil exploration, but the conference committee could never find language acceptable to both chambers. The bill died, and ANWR remains closed to drilling.

It’s important to remember that the House bill passed with just three votes to spare and the Senate bill received exactly the 60 votes needed for passage. Democratic leaders have little room to maneuver as they try to resolve such issues as:

The Public Option: The Senate rejected the concept of a government-run insurance plan to compete with private insurance. Sens. Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.) made it clear that inclusion of the so-called public option would cause them to join a Republican filibuster. They are justifiably concerned that a taxpayer-subsidized government plan would drive private insurance out of the market and lead to a single-payer government-run system.

But the House did include a public option—and retaining it has become the top priority for the Dems’ liberal wing. Public-option advocates seemed willing to go along with a proposed Medicare “buy-in” for those 55 to 64, but even that compromise was dropped from the final Senate bill. Now Rep. Anthony Weiner (D-Brooklyn), among others, has made it clear his vote is in doubt if the final bill does not include some form of public option. And such liberal activist groups as Moveon.org have promised to spend the holiday vacation pressuring their allies to fight for the public option.

Taxes: Both the House and Senate versions contain huge tax hikes, but they take completely different approaches toward which taxes are hiked and who would pay them.

The Senate wants to slap a 40 percent excise tax on “Cadillac” insurance plans. But there’s widespread recognition that insurers will merely pass the tax on to their customers in the form of still higher premiums. And as inflation drives costs higher, more and more plans will be subject to the tax.

While economists and deficit hawks in the Senate see the measure as one of the few cost-control provisions left in the bill, the insurance tax is anathema to labor unions and other powerful Democratic constituencies. It would also break President Obama’s pledge not to raise middle-class taxes.

The House, on the other hand, has gone with a “soak the rich” strategy—calling for a surtax on incomes of $500,000 or more a year. But Democrats already plan to allow the Bush tax cuts to expire next year, raising income taxes for millions of Americans. An income-tax surtax on top of that would mean marginal tax rates of more than 50 percent in high-tax states like New York. That’s a tax increase too far for many Senate Democrats.

Abortion: Sen. Ben Nelson (D-Neb.) forced Senate Democrats to include language restricting federal funding of abortion. But that compromise is already under attack from both sides. Rep. Bart Stupak (D-Mich.), author of tougher anti-abortion language included in the House bill, has said that he won’t support the Nelson language. Other anti-abortion legislators, including Joseph Cao of Louisiana (the only Republican to vote for the House bill), have said that they’ll vote against the final bill unless it includes Stupak’s language.

Yet, abortion-rights advocates in the House, including Rep. Louise Slaughter (D-NY), have written to Speaker Nancy Pelosi, threatening to withhold their support if the final bill includes either the Stupak or Nelson restrictions. “We will not vote for a conference report that contains language that restricts women’s right to choose any further than current law,” they wrote.

There are also differences over an employer mandate (the House includes one, the Senate more or less doesn’t), an individual mandate (the House has strict financial penalties backed up by jail time, the Senate watered down the penalties considerably), and special favors (everyone now wants a deal like the one Sen. Nelson got, with the federal government picking up Nebraska’s share of higher Medicare costs).

Democratic leaders may yet twist enough arms, promise enough pork and fudge enough language to get a final bill passed. But they’ll have to do so amid a rising tide of public opposition.

No wonder the White House now says it expects January’s health-reform talks to last into February, past President Obama’s State of the Union address. The hard part may be just beginning.

Michael Tanner, a Cato Institute senior fellow, is co-author of “Healthy Competition: What’s Holding Back Health Care and How to Free It.”

I asked A. Zarkov what he thought about the Tanner column and he replies:

Tanner makes some good points, but I have a hard time believing that Pelosi, Reid and Obama don’t have this all sewed up. They have too much riding on getting some kind of bill passed. To fail would be a horrendous personal embarrassment for all of them. They will do almost anything. I think Pelosi will simply give in on the public option and whatever else it takes to reconcile the House and Senate versions. In my opinion, the brass ring is the personal mandate together with the whole apparatus that will be set up. Once they get that, then they can go for full nationalization.

- end of initial entry -

Paul Nachman writes:

In this NRO piece from 12/24 about the further course of health-care bills, Ponnuru writes:

Why would any of the 215 no votes switch to yes? Three possible reasons come to mind. First, some congressmen may think that the bill has improved: Perhaps a few Blue Dog Democrats will be pleased, for example, by the abandonment of the public option. Second, they may face more pressure from President Obama and Speaker Pelosi. But presumably the Democrats who voted no were already under a lot of pressure to keep the bill from dying the last time the House voted on it. Having said no earlier, they can probably say no again. (I’m assuming that Pelosi did not have many potential yes votes in reserve.) Third, they may face pressure from voters in their districts to vote for the bill. But this seems unlikely: I haven’t heard of a single congressman who voted no and now regrets it, and the polls do not suggest that a no vote carries electoral risks.

The line I’ve boldfaced is precisely what can’t be assumed.

And I don’t know if you disdain Mark Steyn across the board, but in case not I’ll offer this paragraph that gets at the heart of the danger, more so than the details discussed by Anderson and Tanner:

My Republican friends often seem to miss the point in this debate: The so-called “public option” is not Page 3,079, Section (f), Clause VII. The entire bill is a public option—because that’s where it leads, remorselessly. The so-called “death panel” is not Page 2,721, Paragraph 19, Sub-section (d), but again the entire bill—because it inserts the power of the state between you and your doctor, and in effect assumes jurisdiction over your body. As the savvier Dems have always known, once you’ve crossed the Rubicon, you can endlessly re-reform your health reform until the end of time, and all the stuff you didn’t get this go-round will fall into place, and very quickly.